Called cardiac calcium scoring, the test uses a special x-ray called a CT scan to show the location and extent of calcified plaque in a person's coronary arteries. "Calcium does not deposit in healthy arteries; it deposits in arteries which already have plaque," says Dr. Mike Mounir, a Lafayette cardiologist. "This new technology is making it very easy for us to know if someone is starting to have atherosclerosis [fatty material deposited along the walls of the arteries]. I use this technology to know how aggressive I need to be in treating different patients."
The coronary arteries are the vessels that carry blood to the heart wall. The main cause of heart disease is build-up of plaque, which includes fat and calcium, in the arteries of the heart. When the arteries narrow, the heart muscle doesn't get enough oxygen-containing blood, and a heart attack can occur. The plaque can also break away from the artery walls and cause blockage.
Available in this market for several years, this calcium scoring test is non-invasive, uses no dye or needles and exposes a patient to minimal radiation.
The CT's sub-second scanning capability takes 70 to 90 images of the patient's coronary arteries to derive a calcium score. The entire process takes less than 10 minutes. A fully clothed patient simply lies down on the table attached to the CT scanner while a technologist places a few EKG leads on his chest. The table slides through the opening in the scanner while a cylinder around the opening rotates around his body, and the electrodes ' which are also attached to a machine that records the electrical activity of the heart ' make it possible to record CT scans when the heart is not actively contracting. The patient holds his breath for periods of 20 to 30 seconds while the images are recorded ' and the test is over.
Radiologists like Dr. Henry McLemore of the Acadiana Radiology Group at Our Lady of Lourdes read the results using high tech software that shows the cross-sections, or slices, of the areas of interest and calculate the calcium score. They provide an evaluation within 48 hours.
"We've had some people that took the test and they had calcium, so we checked the other risk factors," McLemore says. "If they'd have kept on, they might have had a heart attack and required more extensive surgery than just a stent."
"The test is most beneficial in middle-aged people, 45 to 50 and above, because young people could have plaques and blockage without calcium deposit," Mounir says. The test also does not detect soft plaque, the earliest form of coronary artery disease.
"If the calcium score is zero in a middle-aged person, that means this person has a 95 percent chance of not having any blockages," the cardiologist continues. While zero means no buildup, a score above 400 indicates significant buildup and plaque ' most likely obstruction of one of the coronary arteries. "If a calcium score is high, that means indirectly that the plaque burden is high also."
The calcium scoring test doesn't indicate if the plaque is obstructive, but a score in the 1,000 to 2,000 range is a likely sign of obstruction, and the patient typically will undergo coronary angiography. This invasive procedure is more risky and much more expensive. Considered the "gold standard" for detecting coronary artery stenosis (the narrowing or obstruction of the heart's aortic valve), it uses dye injected through a thin catheter in the groin or arm to enhance x-ray images of the heart. The tip of the tube is positioned either in the heart or at the beginning of the arteries supplying the heart. The pictures that are obtained are called angiograms, and the physician is able to correct problems during the procedure.
If a person's calcium score is between 100 and 400, other factors must be weighed before additional tests are ordered. "If he does not have chest pain or an abnormal stress test, then he does not need to have any further testing, just starting him on cholesterol medication and aspirin," Mounir says. If the patient is having some chest discomfort and the stress test is inconclusive, the physician may recommend a cardiac CT angiogram, which uses the same calcium scoring CT technology but includes a dye contrast administered intravenously in the arm.
Though vastly improved in terms of the number of slices it produces in a single rotation to create a 3-D image of the heart, cardiac CT angiography still is not sufficient to replace the traditional catheter-based coronary angiography, Mounir says. For example, he says it doesn't produce clear images in an overweight person.
If the calcium scoring reveals a high chance of having heart disease, a person should also take steps such as eating better, quitting smoking and getting more exercise ' lifestyle adjustments similar to those a doctor would recommend after looking at a person's health history, physical health, and any lab tests, such as a cholesterol test.
McLemore has personally undergone the test twice, the second revealing a calcium score of 19 (only a minimal risk), so he simply increased his exercise regimen and continued taking a mild medication for his elevated cholesterol.
The struggle to fight America's No. 1 killer is far from over, but Lafayette's medical community believes early diagnosis through this revolutionary and affordable CT imaging is going a long way toward better managing the crisis. "It not only detects calcium in the arteries; I have seen enlarged hearts, pericardial effusions [fluid around the heart], calcification of the heart valve and evaluations of the aorta," says McLemore. "It's a screening test, but you get a good idea of what the heart and everything else [around it] looks like."
McLemore, however, cautions against leaning on a single test for determining a person's chances of developing coronary artery disease. He says all other risk factors ' high cholesterol, high blood pressure, smoking and diabetes ' must be weighed. "This is a screening test. It should not take the place of a physical exam for detection of your risk factors," the doctor says.
For now in Lafayette a physician has to request the test, but Mounir believes that may soon change ' it has in other states. "I do expect in the future it could be done without a physician order," he says. Mounir's only fear is the test could lead to unnecessary procedures, meaning a higher number of coronary angiograms. "That is why it should be done with the knowledge of a physician who will interpret the test according to the whole clinical picture," he says.
School board members Mark Babineaux, Hunter Beasley and Tehmi Chassion can vote to fire Cooper — because we all know that’s exactly what they’ll do.
District 2 school board candidate Simon Mahan is hoping to unseat first-term incumbent and former Carencro Mayor Tommy Angelle in the Nov. 4 election.
District Attorney Mike Harson is showing his desperation by falsely attributing quotes to his opponent and blocking journalists from his social media.
Three bedroom Acadian or a two bedroom town home
Ready to geaux in purple and gold
The governor is traveling the country laying the groundwork for a possible 2016 presidential campaign, but his approval ratings at home hover well below 50 percent.
State District Judge Bob Downing extended the order and delayed a planned Wednesday hearing about a permanent injunction while negotiations continue between Attorney General Buddy Caldwell and the waste disposal site operator.
New Louisiana higher education commissioner Joseph Rallo will be paid more than his predecessor.
The recently established Downtown Lafayette Restaurant & Bar Association will host a special viewing of the upcoming New Orleans Saints taking on the Carolina Panthers in the open air of Parc Sans Souci on Thursday, Oct. 30.
Belief in a national outbreak of the Ebola zombie virus is becoming more of a threat every day, and The Hayride — Louisiana’s one true bastion for unrelentingly conservative political commentaries — thought it wise to share a certain special someone's “important message” with readers Tuesday on what to do when, not if, it comes.
Acadiana's nightlife guide.
Elijah McGuire and Alonzo Harris each had four rushing touchdowns, and Louisiana-Lafayette rolled to 419 yards on the ground in a 55-40 victory over Arkansas State on Tuesday night.
Bill and Hillary Clinton are the validators-in-chief for Democrats struggling through a bleak campaign season in states where President Barack Obama is deeply unpopular.
JPMorgan Chase is giving $1 million to Louisiana's community and technical colleges, to help with workforce training efforts to match students to available jobs.
President Barack Obama is turning to black radio listeners to plead for midterm votes, a targeted approach to drum up Democratic support at a time when many candidates don't want him around in person.
WaPo Watergate editor Ben Bradlee dies; Clintons stump for Dems; Liberians stranded and more national and international news for Wednesday, October 22, 2014.
Wednesday's Blogs from the Bog!
Law firm unveils newly renovated 200-year-old building.
UL grad named web developer at BBR Creative
Lafayette-based emergency department staffing and management company raises $120 million in senior credit facilities through GE Capital, Healthcare Financial Services.
High-rise apartment building, parking garage, hotel and retail part of new development.
A common thread runs through many of those we oppose: Enshrining in the Constitution protections on programs and their funding sources has had a disastrous effect on Louisiana’s most important economic development engine.
"I am extremely disheartened by the political machines that are attempting to hijack my efforts along with others that advocate for children."
Landrieu, who is fighting to keep her seat for a fourth term, said that Ebola is serious and precautions should be taken, but she accused Republicans of using the virus outbreak in West Africa to "create fear" here at home.
The number of Louisianans with jobs continued to set records in September, but the state's unemployment rate kept rising.
Three bedroom cottage or three bedroom ranch
Sheer lace perfection
Acadiana's nightlife guide.
Louisiana is drowning, quickly.
Law enforcement agencies are participating in a "Louisiana Heroin Summit," designed to address the recent rise in heroin use and drug-related deaths around the state.